Concussion guidelines change for student athletes

Prue SalaskyDaily Press

Adolescent concussions can cause serious long-term injury or death. The still-developing brains of young athletes make them more susceptible to the deleterious effect of a head injury, sometimes characterized in sports as "a bell-ringer" or "ding."

In August, the AAP published a new clinical report, "Sport-Related Concussion in Children and Adolescents," updating its guidelines on the treatment of youth concussions. Among its recommendations are that children or adolescents who sustain a concussion should always be evaluated by a physician and receive medical clearance before returning to play. No more waiting 15 minutes and then going back in as has been common practice.In Virginia that becomes law in July 2011 when legislation sponsored by state Sen. Ralph Northam, a pediatric neurologist, takes effect. The new law will require every school division to inform student athletes and their parents and guardians about the short-term and long-term effects of concussions; it also will require any student suspected of sustaining a concussion to leave the playing field and not return until evaluated and given written permission by a licensed health-care provider.

The details of the bill's implementation will be hammered out in meetings around the state this year.

In the interim, at the urging of the Virginia High School League, school divisions are putting policies in place this year to meet the law's requirements. Hampton schools have instituted use of the ImPACT program, a computerized neurocognitive assessment test that students in high-risk sports take before the season to establish a baseline score. If a concussion is suspected they'll retake the test for comparison purposes before being cleared to play, says Beth Mair, coordinator of athletics.

Newport News instituted the ImPACT test in the spring for athletes in every sport. The tests are valid for two years, says athletic trainer Jason Hollar, who teaches sports medicine at Menchville High School. Last year there were seven verified concussions during the school's athletic year, with football and soccer accounting for most of them.

"I think it's a great thing that we're really recognizing the dangers and long-term effects of just one concussion, and just how much mental processes can be affected," says Hollar.

Brenner cautions that the computer test is just one tool in assessing return to play. His personal priority is for an athletic trainer - "they're qualified and familiar with concussions" - to be on site at practices and games to identify and diagnose any concussion injuries.

"It shouldn't be taken lightly. It's not like a skin cut that repairs itself. Once the brain is injured, it's injured for life," says Northam.

He notes that today's high school athletes are faster and stronger than their predecessors which results in more impact injuries despite better equipment and safety measures. Though football classifies as a high-risk sport, concussions are also incurred by wrestlers, gymnasts, cheerleaders, soccer and basketball players.

Contrary to public perception, only about one in 10 people incurring a concussion actually loses consciousness. More typical symptoms, which can appear immediately or up to 72 hours after impact, include disorientation, memory problems, dizziness, headache and nausea. Subsequent problems can include depression and sleep issues.

One of the greatest concerns is "second impact syndrome" when a second concussion occurs before the brain has recovered from the first one "regardless of how mild both injuries may seem," according to the National Federation of State High School Associations.

The NFSHA has revised its language this year to advise that no athlete suspected of having a concussion should return to the same practice or contest, even if symptoms clear within 15 minutes. Further, it no longer recommends the "grading" of concussions, as often symptoms worsen some time after the head injury.

The difference between an initial concussion and a second impact is significant. In an initial impact, "it's like taking an egg and shaking it. The brain is rattled into crisis mode. The chemicals in the brain are not working properly," says Brenner. In a "second impact" the brain swells and causes permanent damage; about half die from it and survivors are typically impaired to the point where they can't live independently.

For Brenner the new AAP guidelines will serve to increase education, enforce an appropriate rest period for recovery - which should include both physical and intellectual exertion - and protect young athletes from permanent damage.

The same goes for Northam's legislation. In his practice he sees a tremendous pressure from parents and athletes to return before it's safe to do so.

"The legislation will take the pressure off coaches. They welcome it. It's in the best interest of the athlete," he says.

CONCUSSION GUIDELINES

*For the full American Academy of Pediatrics' guidelines, go to pediatrics.aappublications.org and see both the study and report under "First Pages." For the National Federation of State High School Associations "Suggested Guidelines for Management of Concussion in Sports," go to www.nfhs.org

*Read a transcript of last week's Daily Press Web chat on concussions and find more local health news and information at dailypress.com/health

VIDEO ONLINE

To see a video of Dr. Joel Brenner on youth concussions, go to www.chkd.org/video/player.aspx?vid=concussion